MJPJAY: Mahatma Jyotiba Phule Jan Arogya Yojana Eligibility, Benefits, Coverage

To offer free access to good medical care to all ration cardholders in the state, the Maharashtra government launched the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY). The primary goal of this health care scheme is to give access free medical care to the underprivileged and the vulnerable sections of society. 

This article ventures into the eligibility criteria, coverage and benefits of the MJPJAY scheme.

What is Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)?

With an objective to offer free and quality medical care to low-income families, the MJPJAY was launched by the state government of Maharashtra. The scheme offers free medical care especially speciality services which require hospitalisation for consultations, surgeries and therapies through an identified network of health care providers. It was initially launched with the moniker Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY).

The MJPJAY shall provide coverage for meeting all expenses for medical care during hospitalisation of the beneficiary with a sum insured amount of Rs.1,50,000 per family per year. The annual coverage of Rs.1,50,000 can be availed by an individual or the entire family through cashless hospitalisation.

What is Covered Under the Mahatma Jyotiba Phule Jan Arogya Yojana?

The coverage under the Mahatma Jyotiba Phule Jan Arogya Yojana includes about 971 therapies/surgeries/procedures and 121 follow-up packages in 30 specialised categories. These include:

Orthopaedic surgery and procedures, general surgery, ENT surgery, gynaecology and obstetrics surgery, cardiac and cardiothoracic surgery, ophthalmology surgery, pediatric surgery, radiation surgery, plastic surgery, etc.

The government has reserved 132 procedures which are to be performed by empanelled government hospitals or government medical colleges.

The upper limit for renal transplant operation is Rs.2,50,000.

Consultation and medicines post-hospitalisation is covered for up to 10 days from the date of discharge.

What is Not Covered?

Under the scheme, all acceptable medical care will be provided except for the planned 131 procedures such as vaginal or abdominal hysterectomy, hernia, cholecystectomy, appendectomy, discectomy, etc shall be performed only at government empanelled hospitals or government medical colleges.

Features and Benefits of Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY):

Below are the salient features of the MJPJAY:

The health insurance coverage and premium charges are borne by the State Government of Maharashtra.

Sum insured amount of Rs.1,50,000 per year per family.

The scheme can be utilised by an individual or on a family floater basis.

Covers surgeries, diagnostics, medications and follow-up consultations and treatment.

All pre-existing diseases are covered from day one.

Apart from government empanelled hospitals, several private hospitals are included.

Access to health camps conducted at government empanelled hospitals.

Benefits of Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY):

The MJPJAY scheme offers several benefits to people belonging to the BPL and APL families. Below are the benefits of the scheme:

It covers about 971 types of surgeries/therapies/procedures in 30 specialised categories.

It covers about 121 types of follow-up procedures in 30 specialised categories.

Only empanelled government hospitals and medical colleges will perform 132 government reserved procedures.

Renal transplant upper ceiling is at Rs.2,50,000.

List of Diseases and Treatments Covered Under MJPJAY:

All pre-existing diseases are covered from day one under the scheme, below is the list of diseases and treatments covered under the MJPJAY:

General Surgery

Opthamology Surgery

ENT Surgery

Gynecology and Obstetrics Surgery

Surgical Gastroenterology

Orthopedic Surgery and Procedures

Cardiac and Cardiothoracic Surgery

Genitourinary System

Pediatric Surgery

Surgical Oncology

Neurosurgery

Medical Oncology

Plastic Surgery

Radiation Oncology

Burns

Prostheses

Polytrauma

Critical Care

Infectious Disease

General Medicine

Pediatrics Medical Management

Nephrology

Cardiology

Neurology

Dermatology

Pulmonology

Rheumatology

Gastroenterology

Endocrinology

Interventional Radiology

Eligibility for Mahatma Jyotiba Jan Arogya Yojana (MJPJAY):

Below is the eligibility criteria of Mahatma Jyotiba Jan Arogya Yojana (MJPJAY):

Families who are part of the identified distressed districts of the state of Maharashtra.

Should hold White/Orange/Yellow Ration Card, Antyodaya Anna Yojana Card (AAY) or Annapurna Card.

Farmers from several agriculturally distressed districts such as Amaravati, Aurangabad, Akola, Buldhana, Hingoli, Beed, Jalna, Latur, Nanded, Osmanabad, Wardha, Parbhani, Yavatmal and Washim.

The basis of identifying farmers from these agriculturally distressed districts is based on the 7/12 extract, their White Ration Card and the name of the beneficiary or the head of the family or certificate from the concerned Patwari or Talathi.

How to Enrol in Mahatma Jyotiba Jan Arogya Yojana (MJPJAY) Scheme?

Below is the enrollment process for the MJPJAY scheme in the state of Maharashtra:

Step 1: Individuals or families shall approach nearby Network/District/Women/General hospital and meet Arogyamitra to initiate the application for the scheme.

Step 2: If you visit a Government Health Facility, a referral card will be provided to you which can be presented to the Network Hospital along with the preliminary diagnosis by the doctors conducted at the Government Health Facility.

Step 3: You can also attend Health Camps organised by the Network Hospital and get the referral card.

Step 4: You are then required to provide the referral card along with your Yellow or Orange Card. You can also produce your Antyodaya or Annapurna Card instead of a ration card.

Step 5: Once you have produced the above details, diagnosis and check-ups will be initiated.

Step 6: Based on the diagnosis, you will be admitted to the Network Hospital.

Step 7: An E-authorisation request will be sent to the insurance company and the same will be reviewed by the MJPJAY as well.

Step 8: Medical Specialists of the insurance company and MJPJAY will review the request for authorization and approve the request if all conditions are met. This authorization will be done in 24 hours and immediately in case of an emergency with the authorization is marked as “EM”.

Step 9: With the authorisation approved, cashless treatment or hospitalisation will be extended to you. 

Step 10: The hospital will send all the original bills, diagnostic reports, discharge summary, and other relevant documentation to the insurance company for the settlement of the claim.

Step 11: The insurance company will review the documents and approve the claim and clear the payment to the hospital.

Step 12: The network hospital will provide free consultations, medicines and diagnostics under the scheme for up to 10 days from the date of discharge.

Documents Required to Apply for Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY):

For identification purpose, apart from the ration card (Orange/Yellow/White), you need to submit any of the following KYC documents:

Pan Card

Driving License

Aadhar Card

Voter ID

Handicap Certificate

Nationalized Bank Passbook with Photograph

School/College ID

For urban areas, Government Local bodies/Tahsildar’s stamps and signatures on the applicant’s photograph.

For rural areas, Tahsildar’s stamp and signature on the applicant’s photograph.

Passport

Freedom Fighter ID Card

Senior citizen card issued by central and state government Of India

Defence ex-service card issued by Sainik board

Any photo ID proof issued by Govt. of Maharashtra/ Govt. of India.

Marine Fishers Identity card. 

In the case of a newborn child wherein, the name and photo are not available on the card or on the valid Yellow or Orange Ration card, submit the photograph of the child along with either of the parents along with White/Orange/Yellow ration card and the child’s birth certificate.

How to Apply for Mahatma Jyotiba Jan Arogya Yojana Card Online?

To apply or to get the Mahatma Jyotiba Jan Arogya Yojana card, you need to approach the nearby General, Women/District/Network hospital. Arogyamitra, who is the representative of the scheme, shall facilitate in getting the health card for you.

Please note, if you visit the Government Health Facility, you will be provided with a referral card to the Network hospital to initiate preliminary diagnosis by the doctors. You can also attend Health Camps conducted by the Network hospitals and can get the health card.

Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) Application Form:

The main objective of the government to launch this health scheme is to provide free access to health care to the poor and the vulnerable sections of the society, especially those who belong to the BPL and APL families.

To apply for the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) scheme, beneficiaries should approach nearby General, Women, District or Network hospital to enrol themselves.

Claim Procedures of Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY):

Below is the claim procedure of MJPJAY scheme:

Step 1: A diagnosis is conducted to find out the condition.

Step 2: Treatment will begin immediately if the diagnosis is made in a network hospital as soon as the pre-authorisation is received from the insurance company.

Step 3: If the diagnosis is not conducted in a network hospital, then a referral card will be provided by the Arogyamitra to begin the treatment at the empanelled hospital. 

Step 4: The network hospital will obtain e-authorisation from the insurance company through online mode.

Step 5: Upon receiving the authorization from the insurance company, the empanelled hospital will commence the treatment. 

Step 6: Once the treatment and surgery are completed, the hospital will share all the relevant documents such as medical bills, diagnostics, discharge summary to the insurance company.

Step 7: The insurance provider will verify all the relevant documents and approve the claim settlement.

Step 8: The network hospital will offer consultations, diagnostic and medicines for up to 10 days from the date of discharge.